Shiga Toxin-Associated Hemolytic Uremic Syndrome: Specificities of Adult Patients and Implications for Critical Care Management

Abstract

Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is a form of thrombotic microangiopathy secondary to an infection by an enterohemorrhagic E. coli. Historically considered a pediatric disease, its presentation has been described as typical, with bloody diarrhea at the forefront. However, in adults, the clinical presentation is more diverse and makes the early diagnosis hazardous. In this review, we review the epidemiology, most important outbreaks, physiopathology, clinical presentation and prognosis of STEC-HUS, focusing on the differential features between pediatric and adult disease. We show that the clinical presentation of STEC-HUS in adults is far from typical and marked by the prevalence of neurological symptoms and a poorer prognosis. Of note, we highlight knowledge gaps and the need for studies dedicated to adult patients. The differences between pediatric and adult patients have implications for the treatment of this disease, which remains a public health threat and lack a specific treatment.

Loads of Coliforms and Fecal Coliforms and Characterization of Thermotolerant Escherichia coli in Fresh Raw Milk Cheese

“…The pathogenicity of STEC is mainly reliant on the development of one or two Shiga toxins (Stx1, Stx2), causing mild to severe symptoms of hemorrhagic colitis (HC). However, two major lethal syndromes, namely hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP), have been reported as outcomes associated with STEC infection [13].…”

Occurrence, Pathogenic Potential and Antimicrobial Resistance of Escherichia coli Isolated from Raw Milk Cheese Commercialized in Banat Region, Romania

“…The results of several epidemiological investigations reviewed by Kaper et al [ 3 ] have demonstrated the link between the occurrence of severe food-borne disease outbreaks, or even deaths, and the consumption of raw dairy products contaminated with different diarrheagenic E. coli strains. Studies focused mainly on monitoring the Shiga-toxin-producing E. coli (STEC) strains found in food matrices, due to their toxicity and infectious potential, related to the toxin productions (e.g., Stx1 or Stx2), which generate hemorrhagic colitis, as well as two other major lethal syndromes in human patients, namely, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome [ 4 , 5 , 6 ].…”

Serious and Atypical Presentations of Bartonella henselae Infection in Kidney Transplant Recipients

“…The resultant inflammatory reaction could help bacteria to form vascular tumors through the production of cytokines and vasoproliferative factors [ 1 ]. It could also induce endothelial damage, by a proinflammatory context and by activating the complement pathway, similar to the Shiga toxin–producing Escherichia coli –associated hemolytic uremic syndrome [ 8 , 9 ]. As previously described, Bartonella species partially escape complement activation by a modified lipopolysaccharide chain, but it is possible that immunocompromised hosts have higher bacterial load and complement activation occurs anyway [ 10 ].…”